The short answer is YES, you should make a preconception appointment. But only 14% of people get preconception care and about 50% of pregnancies are unintended/unplanned.
But let’s start with what preconception care is!
Preconception care is a visit with your healthcare or obstetric provider before you become pregnant to review your entire health history, prior pregnancies or prior pregnancy complications, any notable risk factors for you or within your family tree (ex. history of Down’s Syndrome, sickle cell trait, thalassemias, very premature preterm births (<34 weeks), history of pre-eclampsia, etc…).
There is a lot of Q+A and education (read this post for the deep dive into the education and history). Usually the visit is just a talking visit – that means you get to keep your pants on unless you are due for a pap smear and elect to complete that screening or your provider recommends other testing that requires a pelvic exam (FYI: You can test for gonorrhea, chlamydia and trichomonas from a urine sample).
Sometimes your provider will recommend baseline blood work testing. This typically involves carrier screening for cystic fibrosis, spinal muscular atrophy and fragile X. Sometimes your provider will include blood tests for HIV, hepatitis B, hepatitis C, and syphilis. All of this testing can be completed after you become pregnant (usually this is done at the first pregnancy visit) but some people elect to do testing prior to becoming pregnant.
Most providers will not repeat the testing after you become pregnant as long as the labs were within the last year and you do not have other risk factors.
Let’s break it down a little more with some Q+A…
Who should make a preconception appointment?
Most people. Really, Jamie? Most people? Yes. I don’t think I would have told you that as a new midwife 10 years ago but as a seasoned midwife that has done 1,000 first pregnancy visits, that’s my recommendation.
Here’s why: The first pregnancy visit is a lot of information, questioning and decision making and most people/couples are simply overwhelmed by the visit. There is an opportunity to skip the overwhelm and discuss 80% of the content at a preconception visit. And, here’s the cool thing, whether you got pregnant after your next period or 11 months later, most of the information, planning and education is unchanged. That’s why the visit is so valuable.
I especially think this visit is valuable for anyone with anxiety, on medications for mood disorders, couples with infertility, history of premature preterm birth, couples with history of miscarriage – especially recurrent miscarriages, and any pre-eclampsia.
What types of providers offer preconception care?
Any provider that offers obstetric care should offer preconception care.
If they aren’t sure what to ask you, take the preconception tool with you as a talking aid 🙂
You both can use the template as a guide to make sure everything that evidence recommends reviewing is covered.
Can I ask about preconception care appointments during my postpartum education?
YES. YES. YES.
In fact, this is where I plant the seed for postpartum education.
Pre-eclampsia with severe features on magnesium sulfate going home from the hospital?
Please come see me for a preconception appointment after your postpartum visit so we can talk about the risk of pre-eclampsia in other pregnancies, the use of aspirin to reduce that risk, and any lifestyle changes we can find that may reduce your risk even further,
Just had a 30 week baby boy after your bag of water broke unexpectedly with your first pregnancy?
Please come see me for a preconception appointment after your postpartum visit so we can talk about the risk of preterm birth in your future pregnancies and how we would monitor your next pregnancy differently.
Going home after an induction for gestational diabetes and worried about gestational diabetes in other pregnancies?
Please come see me for a preconception appointment after your postpartum visit so we can look at what lifestyle changes may reduce your risk of diabetes during your next pregnancy (I’m looking at your books Lily Nichols!)
You guys get the idea…there is a lot of education and counseling that providers can offer between pregnancies that greatly affects the next pregnancy.
Can’t we do preconception care at the postpartum visit?
You can. But sometimes the postpartum visit is consumed with breastfeeding questions, contraceptive counseling or placement (IUD or Nexplanons) or even mood management if there is postpartum depression or anxiety.
In practice, providers should always be doing preconception care; the healthcare system isn’t set up to accommodate that kind of opportunity though, so providers have to create the time to do it unless the patient or family makes an appointment specifically for that.
What other resources review preconception care?
CDC: Preconception | Checklist for pregnancy.
Handout (PDF): Preconception Health and Health Care My Reproductive Life Plan (CDC)
PDF: Pursuing Motherhood (Workbook on preparing for pregnancy)
Show Your Love | Website aimed a wellness.
Preconception Template | All underlined words are active hyperlinks when you click on the PDF!
What tips do you have for providers?
Try to incorporate preconception care into your regular visits whenever you can. I like to give a preconception handout to any well woman visit that isn’t preventing pregnancy or is planning to become pregnant.
I’ll do the same at postpartum visits. Even with contraceptive counseling, providers should ask what the family plan is (how many children are you planning and what kind of spacing?). This offers another opportunity to counsel about closely spaced pregnancies, possibility of vaginal birth after cesarean, etc.
In short, when you can get or give preconception care, both the mother, baby and the family are likely to benefit.
Hope this was helpful to you! Don’t forget to download your preconception template for FREE on the TOOLS & HANDOUTS page.
1 year ago on the blog…Behind The Scenes Lately…